PRINTER'S NO. 2872
No. 2274 Session of 1991
INTRODUCED BY WILLIAMS, THOMAS, KOSINSKI, J. TAYLOR, OLIVER,
VEON, CARONE, KENNEY, SAURMAN, TIGUE, ULIANA, ITKIN,
BELFANTI, BISHOP, LLOYD, PISTELLA, RITTER, SCHULER, CAWLEY,
FOX, WOGAN, RICHARDSON, COWELL, LINTON, NYCE, CORRIGAN,
O'BRIEN, KING AND CIVERA, DECEMBER 10, 1991
REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE,
DECEMBER 10, 1991
AN ACT
1 Amending the act of December 20, 1985 (P.L.457, No.112),
2 entitled "An act relating to the right to practice medicine
3 and surgery and the right to practice medically related acts;
4 reestablishing the State Board of Medical Education and
5 Licensure as the State Board of Medicine and providing for
6 its composition, powers and duties; providing for the
7 issuance of licenses and certificates and the suspension and
8 revocation of licenses and certificates; providing penalties;
9 and making repeals," regulating the practice of respiratory
10 care practitioners.
11 The General Assembly finds and declares that the practice of
12 respiratory care in this Commonwealth affects the public health,
13 safety and welfare and is to be subject to regulation and
14 control in the public interest to protect the public from the
15 unauthorized and unqualified practice of respiratory care and
16 from unprofessional conduct by persons certified to practice
17 respiratory care.
18 The General Assembly of the Commonwealth of Pennsylvania
19 hereby enacts as follows:
20 Section 1. The act of December 20, 1985 (P.L.457, No.112),
1 known as the Medical Practice Act of 1985, is amended by adding
2 a section to read:
3 Section 13.1. Respiratory care practitioners.
4 (a) Creation of advisory committee, method of appointment
5 and term of office.--
6 (1) There is hereby created the Advisory Committee for
7 the Practice of Respiratory Care. It shall consist of three
8 individuals as follows:
9 (i) One physician, licensed to practice in this
10 Commonwealth, who shall be a medical director of
11 respiratory care services and who does not need to be a
12 member of the State Board of Medicine.
13 (ii) Two certified respiratory care practitioners,
14 who shall have practiced respiratory care for a minimum
15 of 36 months. The initial representative appointees shall
16 be qualified to receive certification under this section.
17 (2) (i) Within 90 days after the effective date of this
18 section, the Governor, with the advice and consent of a
19 majority of the members elected to the Senate, shall
20 appoint the members of the committee.
21 (ii) In appointing a person to fill a vacancy in the
22 committee position designated to be held by certified
23 respiratory care practitioners, the Governor shall select
24 a respiratory care practitioner. The Pennsylvania Society
25 for Respiratory Care, Inc., which represents the
26 respiratory care profession in this Commonwealth, shall
27 submit a list of names of qualified respiratory care
28 practitioners willing to serve on the committee for the
29 Governor's consideration. The Pennsylvania Society for
30 Pulmonary Medicine, or that body which represents
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1 pulmonary physicians in this Commonwealth, shall submit a
2 list of names of qualified physicians willing to serve on
3 the committee for the Governor's consideration.
4 (3) (i) The term of office of each appointed member
5 shall be three years or until his successor has been
6 appointed and qualified, but not longer than six months
7 beyond the three-year period. The initial appointed
8 members shall serve terms as follows:
9 (A) One initial respiratory care practitioner,
10 three years.
11 (B) The initial physician member, two years.
12 (C) One initial respiratory care practitioner,
13 one year.
14 (ii) A member appointed to fill a vacancy occurring
15 other than by expiration of a term shall be appointed for
16 the remainder of the unexpired term.
17 (iii) Members of the committee shall be eligible for
18 reappointment. Members shall receive reimbursement for
19 reasonable expenses incurred while engaged in the
20 discharge of official duties, as well as an initial per
21 diem allowance of $30 which may be increased or reduced
22 from time to time by action of the Executive Board of the
23 Commonwealth.
24 (4) The committee shall elect annually, from its
25 membership, a chairperson, a vice chairperson and a
26 secretary. A quorum shall be a majority of the voting
27 members.
28 (b) Powers and duties of advisory committee.--The advisory
29 committee shall make recommendations to the State Board of
30 Medicine concerning the following:
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1 (1) The administrative procedures for processing
2 applications and issuing certificates to respiratory care
3 practitioners and for disciplinary proceedings pursuant to
4 the provisions of this section.
5 (2) Contracting with a professional testing organization
6 for the preparation and administration of the examination for
7 respiratory care practitioners, in accordance with section
8 812.1(a) of the act of April 9, 1929 (P.L.177, No.175), known
9 as The Administrative Code of 1929.
10 (3) The qualifications of applicants for certification,
11 conducting examinations, establishing passing criteria for
12 the examination, and issuing and renewing certificates to
13 respiratory care practitioners.
14 (4) Adopting and, from time to time, revising such rules
15 and regulations as may be necessary to carry out the
16 provisions of this section.
17 (5) Examining, denying, approving, issuing, revoking,
18 suspending or renewing certificates of respiratory care
19 practitioners pursuant to this section and conducting
20 hearings in connection therewith.
21 (6) Conducting hearings upon complaints concerning
22 violations of the provisions of this section and the rules
23 and regulations adopted pursuant to this section and seeking
24 the prosecution and enjoinder of all such violations.
25 (7) Expending moneys necessary to carry out its duties.
26 (8) Establishing fees for the operation of the
27 committee, including fees for the issuance and renewal of
28 certificates and for examinations.
29 (c) Certificate required.--
30 (1) It shall be unlawful, 18 months after the effective
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1 date of this section, for any person to practice or to
2 indicate an ability to practice respiratory care unless
3 certified or having a temporary permit under the provisions
4 of this section.
5 (2) A person shall not use the title "Respiratory Care
6 Practitioner," "Respiratory Care Practitioner - Certified,"
7 or the credentials "RCP" or "RCP-C," or any title as it
8 relates to the practice of respiratory care unless certified
9 in accordance with the requirements set forth in this
10 section. A health care institution, health care service,
11 health plan or other institution shall not hold itself out as
12 providing respiratory care services unless the respiratory
13 care services provided by it are performed by a person
14 certified under this section.
15 (3) Upon payment of a fee, the board may issue a
16 temporary permit to practice respiratory care as defined in
17 this act for a period of 12 months pending compliance with
18 the requirements for certification, providing the applicant
19 shows written evidence, verified by oath, that the applicant
20 is currently practicing without a certification, registry or
21 license or is a student in an approved educational program
22 who expects to graduate within the next 30 days. The board
23 may extend the validity of a temporary permit.
24 (d) Persons and practices not affected.--This section shall
25 not be construed as preventing or restricting the practices,
26 services or activities of:
27 (1) A person licensed or certified by the Commonwealth
28 to provide health care services, including, but not limited
29 to, physicians, physical therapists, chiropractors, nurses,
30 dentists, physician assistants and podiatrists.
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1 (2) A person rendering respiratory care services
2 pursuant to his employment by a Federal agency.
3 (3) A person pursuing a course of study leading to a
4 degree or certificate in respiratory care in an accredited or
5 approved educational program, provided he demonstrates
6 satisfactory progress in that program, is designated by a
7 title which clearly indicates the status of student or
8 trainee and not a certified respiratory care practitioner and
9 provides respiratory care under supervision.
10 (4) A person acting upon the instructions of a
11 physician, by prescription, certificate of medical necessity
12 or otherwise, who delivers, installs, monitors, maintains or
13 provides services only with respect to a device which enables
14 an individual to self-administer respiratory care.
15 (e) Requirements for certification.--An applicant applying
16 for the examination as a respiratory care practitioner shall
17 submit a written application on forms provided by the board
18 evidencing to the satisfaction of the board that he meets the
19 following requirements:
20 (1) Is of good moral character.
21 (2) (i) Has completed the academic requirements of a
22 respiratory care training program as defined in this
23 section; or
24 (ii) has provided respiratory care as defined in
25 this section for at least 12 months prior to the
26 enactment of this section, but who is not designated as a
27 "Certified Respiratory Therapy Technician" or "Registered
28 Respiratory Therapist" by the National Board for
29 Respiratory Care, Inc.
30 (3) Has not been convicted of a felony under the act of
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1 April 14, 1972 (P.L.233, No.64), known as The Controlled
2 Substance, Drug, Device and Cosmetic Act, or of an offense
3 under the laws of another jurisdiction, which, if committed
4 in this Commonwealth, would be a felony under The Controlled
5 Substance, Drug, Device and Cosmetic Act, unless:
6 (i) at least ten years have elapsed from the date of
7 conviction;
8 (ii) the applicant satisfactorily demonstrates to
9 the board that he has made significant progress in
10 personal rehabilitation since the conviction, that
11 licensure of the applicant should not be expected to
12 create a substantial risk of harm to the health and
13 safety of his clients or the public or a substantial risk
14 of further criminal violations; and
15 (iii) the applicant otherwise satisfies the
16 qualifications contained in or authorized by this
17 section.
18 As used in this paragraph, the term "convicted" includes a
19 judgment, an admission of guilt or a plea of nolo contendere.
20 (f) Examination.--
21 (1) Any person meeting the requirements of subsection
22 (e) may submit an application for examination.
23 (2) The board shall conduct examinations for
24 certification of respiratory care practitioners no less than
25 two times per year in such geographical locations as are
26 deemed advantageous to the majority of applicants.
27 (3) The examination given for respiratory care
28 practitioners shall be the same as or equivalent to the
29 entry-level examination given by the National Board for
30 Respiratory Care, Inc. The board shall annually review the
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1 examination and standards. Each applicant who achieves the
2 score established by the board shall be entitled to
3 certification as a respiratory care practitioner.
4 (4) The board shall not issue a certificate to an
5 applicant who is under investigation in another jurisdiction
6 for an offense which would constitute a violation of this
7 section.
8 (g) Waiver of certain requirements for certification.--The
9 board shall issue a certificate without examination to:
10 (1) A person filing an application within two years from
11 the effective date of this section who presents evidence
12 satisfactory to the board that, prior to the effective date
13 of this section, the applicant was a certified respiratory
14 therapy technician or a registered respiratory therapist, as
15 certified or registered by the National Board for Respiratory
16 Care, Inc., or held an equivalent credential acceptable to
17 the board and practiced within this Commonwealth prior to the
18 effective date of this section.
19 (2) A person who presents evidence satisfactory to the
20 board of being certified, licensed or registered as a
21 respiratory care practitioner by another state, the District
22 of Columbia or a territory of the United States, or being a
23 certified respiratory therapy technician or a registered
24 respiratory therapist, as certified or registered by the
25 National Board for Respiratory Care, Inc., and practicing in
26 another state, the District of Columbia or a territory of the
27 United States where the requirements for licensure,
28 registration or certification on the date of his licensure,
29 registration or certification were substantially equal to the
30 requirements set forth in this section.
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1 (h) Use of title.--Only an individual who is issued a
2 certificate as a respiratory care practitioner under the
3 provisions of this section may use the title "Respiratory Care
4 Practitioner" or "Respiratory Care Practitioner - Certified" and
5 the letters "RCP" or "RCP-C" in connection with the title or
6 place of business to denote his certification under the
7 provisions of this section.
8 (i) Practice of respiratory care.--A certified respiratory
9 care practitioner may:
10 (1) Implement direct respiratory care to an individual
11 only upon:
12 (i) physician prescription, certificate of medical
13 necessity or referral;
14 (ii) upon approval by a physician, standing orders,
15 protocols or care plans; or
16 (iii) under medical direction and approval by an
17 institution's physician governing body, standing orders,
18 protocols or care plans.
19 (2) Enter a case for the providing of indirect services,
20 consultation or evaluation of an individual as to the need
21 for respiratory care services, provided, however, that direct
22 respiratory care may only be performed pursuant to paragraph
23 (1).
24 (j) Unlawful acts.--It shall be unlawful for anyone who is
25 not certified or exempt under the terms of this section to hold
26 himself out to the public as performing any of the following:
27 (1) Administration of medical gases.
28 (2) Humidity and aerosol therapy.
29 (3) Administration of aerosolized medications.
30 (4) Intermittent positive pressure breathing.
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1 (5) Incentive spirometry.
2 (6) Bronchopulmonary hygiene.
3 (7) Management and maintenance of natural airways.
4 (8) Maintenance and insertion of artificial airways.
5 (9) Cardiopulmonary rehabilitation.
6 (10) Management and maintenance of mechanical
7 ventilation.
8 (11) Measurement of ventilatory flows, volumes and
9 pressures.
10 (12) Analysis of ventilatory gases and blood gases.
11 (k) Renewal of certificate; suspension or revocation.--
12 (1) A certificate issued under this section shall be
13 renewed biannually upon payment of the renewal fee prescribed
14 by the board. The certificate shall expire unless renewed in
15 the manner prescribed by the regulation of the board. The
16 board may provide for the late renewal of a certificate upon
17 the payment of a late fee. A late renewal of a certificate
18 shall not be granted more than six months after its
19 expiration. A certificate shall be renewed after the six-
20 month period only by complying with subsection (f). The board
21 may establish additional educational requirements for
22 certificate renewal designed to assure continued competency
23 of the applying and renewing respiratory care practitioners.
24 (2) A suspended certificate shall expire at the end of
25 its term and may be renewed as provided in this subsection.
26 The renewal shall not authorize the certificate holder, while
27 the certificate remains suspended, to engage in the
28 prescribed activities or in any other activities in violation
29 of the order or judgment by which the certificate was
30 suspended. Whenever a certificate revoked on disciplinary
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1 grounds is reinstated, the certificate holder, as a condition
2 of reinstatement, shall pay a renewal fee and any late fee
3 that may be applicable.
4 (l) Refusal, suspension or revocation of certificate;
5 refusal to renew.--
6 (1) The board shall have authority to refuse, revoke or
7 suspend a certificate for any or all of the following
8 reasons:
9 (i) Failing to demonstrate the qualifications for
10 certification contained in this section or regulations of
11 the board.
12 (ii) Making misleading, deceptive, untrue or
13 fraudulent representations in the practice of respiratory
14 care; practicing fraud or deceit in obtaining a
15 certification to serve as a respiratory care
16 practitioner; or making a false or deceptive biennial
17 registration with the board.
18 (iii) Conviction of a felony in this Commonwealth or
19 any other state, territory or country. As used in this
20 subsection, the term "conviction" includes a finding or
21 verdict of guilt, an admission of guilt or a plea of nolo
22 contendere.
23 (iv) Having his certification to serve as a
24 respiratory care practitioner revoked or suspended or
25 having other disciplinary action taken, or his
26 application for certification refused, revoked or
27 suspended by the proper certifying authority of another
28 state, territory or country.
29 (v) Being unable to serve as a respiratory care
30 practitioner with reasonable skill and safety to the
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1 physician's patients by reason of illness, drunkenness,
2 excessive use of drugs, narcotics, chemicals, any other
3 type of material or as a result of any mental or physical
4 condition.
5 (vi) In enforcing subparagraph (v), the board shall,
6 upon probable cause, have authority to compel a
7 respiratory care practitioner to submit to a mental or
8 physical examination by physicians designated by it.
9 Failure of a respiratory care practitioner to submit to
10 such examination shall constitute an admission of the
11 allegations against him unless the failure is due to
12 circumstances beyond his control, consequent upon which a
13 default and final order may be entered without the taking
14 of testimony or presentation of evidence. A respiratory
15 care practitioner affected under this subparagraph shall
16 at reasonable intervals be afforded an opportunity to
17 demonstrate that he can resume the competent practice of
18 respiratory care with reasonable skill and safety to
19 patients.
20 (vii) Violating a lawful regulation promulgated by
21 the board or violating a lawful order of the board,
22 previously entered by the board in a disciplinary
23 proceeding.
24 (viii) Knowingly rendering medical care and services
25 except under the supervision and direction of the
26 supervising physician.
27 (ix) Being guilty of immoral or unprofessional
28 conduct shall include any departure from, or the failure
29 to conform to, the standards of acceptable and prevailing
30 practice for respiratory care practitioners, in which
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1 proceeding actual injury to a patient need not be
2 established.
3 (2) When the board finds that the certification of a
4 respiratory care practitioner may be refused, revoked or
5 suspended under the terms of paragraph (1), it may:
6 (i) Deny the application for certification.
7 (ii) Administer a public or private reprimand.
8 (iii) Revoke, suspend, limit or otherwise restrict a
9 certification as determined by the board.
10 (iv) Require a respiratory care practitioner to
11 submit to the care, counseling or treatment of a
12 physician or physicians designated by the board.
13 (v) Suspend enforcement of its finding thereof and
14 place him on probation with the right to vacate the
15 probationary order for noncompliance.
16 (vi) Restore or reissue, in its discretion, a
17 certification to serve as a respiratory care
18 practitioner, and impose any disciplinary or corrective
19 measure which it might originally have imposed.
20 (3) Actions of the board shall be taken subject to the
21 right of notice, hearing and adjudication and the right of
22 appeal in accordance with the provisions of 2 Pa.C.S.
23 (relating to administrative law and procedure).
24 (m) Definitions.--As used in this section, the following
25 words and phrases shall have the meanings given to them in this
26 subsection:
27 "Board." The State Board of Medicine.
28 "Certification." The process an individual undergoes to
29 receive a written declaration, legally authenticated, verifying
30 as being of the standard quality and preparation required by the
19910H2274B2872 - 13 -
1 board.
2 "Committee." The Advisory Committee for the Practice of
3 Respiratory Care.
4 "Medical director of respiratory care." A licensed physician
5 who is a board-eligible or board-certified pulmonologist or a
6 board-certified anesthesiologist or an anesthesiologist in the
7 examination system or an internist or an osteopathic physician
8 who devotes a predominance of practice to pulmonary medicine
9 designated by a health care facility or health care agency to
10 assure the quality, safety and appropriateness of its
11 respiratory care services.
12 "Respiratory care." A health care specialty employing
13 evaluation, analysis, care and treatment of patients with
14 cardiopulmonary disorders and related diseases.
15 "Respiratory care practitioner." A natural person who is
16 eligible for credentialing under the provisions set forth in
17 this section to practice respiratory care and uses the
18 professional credential "RCP."
19 "Respiratory care practitioner - certified." A natural
20 person who has successfully completed the certification process
21 as specified under the provisions set forth in this section to
22 practice respiratory care and uses the professional credential
23 "RCP-C."
24 "Respiratory care training program." A program accredited or
25 recognized by the American Medical Association's Committee on
26 Allied Health Education and Accreditation.
27 Section 2. This act shall take effect in 60 days.
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